Healthcare Provider Details

I. General information

NPI: 1881961191
Provider Name (Legal Business Name): CRAWFORD MEDICAL SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 04/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2608 N MAIN AVE SUITE 2
SAN ANTONIO TX
78212-2919
US

IV. Provider business mailing address

2608 N MAIN AVE SUITE 2
SAN ANTONIO TX
78212-2919
US

V. Phone/Fax

Practice location:
  • Phone: 210-225-7400
  • Fax: 210-569-6266
Mailing address:
  • Phone: 210-225-7400
  • Fax: 210-569-6266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335G00000X
TaxonomyMedical Foods Supplier
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. PREM KALIDINDI
Title or Position: MANAGING MEMBER
Credential:
Phone: 917-769-8014